神经根型颈椎病患者颈部痛敏点位置与双手掌温差的关系探讨

Study on the correlation between the position of cervical pain sensitive points and the temperature difference between palms in patients with cervical spondylotic radiculopathy

目的:探讨神经根型颈椎病患者颈部痛敏点分布与双侧掌温差的关系,为临床针灸推拿治疗靶点提供参考。方法:选取2022年3月-9月在北京市第二医院康复科门诊就诊的90例神经根型颈椎病(颈5-6/6-7节段)患者,通过按压确定患者颈部压痛点,同时用红外热像仪测量患者双手掌温,探讨二者之间的关系。结果:88例患者双掌温存在温差,双手掌温差均值为(0.45±0.08)℃,与健康组掌温差(0.15±0.11℃)比较,差异有统计学意义(P<0.001)。34例(37.8%)患者痛敏点分布在颈部横突前方对应体表,18例(20.0%)患者痛敏点分布在后关节突对应体表,38例(42.2%)患者痛敏点同时分布在颈部横突前方对应体表和后关节突对应体表。神经根型颈椎病患者双手掌温差存在两种类型,一种类型为患侧手掌温高,一种类型为患侧手掌温低,患侧手掌温低组中50例患者存在颈部横突前方痛敏点,18例同时在颈部横突前方与后关节突对应体表部出现,32例只出现在颈部前方。患侧手掌温高组中38例患者都存在颈部关节突对应体表痛敏点,20例同时出现在颈部后方关节突对应体表与颈部横突前方处,18例只出现在颈部后方。结论:神经根型颈椎病患者双手掌存在较大温差,患侧掌温高提示存在颈椎后关节突关节对应体表痛敏点,患侧掌温低提示存在颈椎横突前方痛敏点。

Objective To explore the relationship between the distribution of cervical pain sensitive points and bilateral palmar temperature difference in patients with cervical spondylotic radiculopathy,and to provide reference for clinical target of acupuncture and massage therapy.Methods 90 patients with cervical spondylotic radiculopathy(c5-6/6-7)were selected from Department of Rehabilitation in the Outpatient of the Second Hospital of Beijing from March to September 2022.The pressure pain points were determined by pressing,the temperature of both palms of patients was measured by infrared thermography at the same time,and the relationship between palmar temperature difference and pressure pain points was discussed.Results 88 patients had palmar temperature difference,the mean value of palmar temperature difference was(0.45±0.08)℃,which was significantly different from that of the healthy group(0.15±0.11℃)(P<0.001).In 34 patients(37.8%),pain sensitive points were located on the body surface in front of the transverse process of the neck;and in 18 patients(20.0%),pain sensitive points were located on the body surface of the posterior process;in 38 patients(42.2%),the pain sensitive points were located on the anterior surface of the transverse process of the neck and the corresponding surface of the posterior facet.There were two types of palmar temperature difference in patients with cervical spondylotic radiculopathy,one was high palmar temperature on the affected side,the other was low palmar temperature on the affected side,18 cases appeared in the front of the transverse process of the neck and the corresponding body surface of the posterior facet,32 cases only appeared in the front of the neck.In the high temperature group,38 patients had pain sensitive spots on the surface of the cervical facet,20 patients had pain sensitive spots on the surface of the cervical posterior facet and the front of the cervical transverse process,and 18 patients only had pain sensitive spots on the back of the neck.Conclusion There is a temperature difference between the palms of the patients with cervical spondylotic radiculopathy.High palmar temperature on the affected side indicates that there is a pain sensitive point corresponding to the posterior facet joint of the cervical spine,while low palmar temperature on the affected side indicates that there is a pain sensitive point in front of the transverse process of the cervical spine.